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Background: In a cognitive perspective, chronic pain comprises at least three dimensions: First it is possible to study the relevance of pain related attitudes, beliefs and coping cognitions for the chronification of pain. Second psychological processes of learning and memory processes can be analysed. Third we can investigate uncontrolled cognitions in chronic pain patients., Aim of the Study: The first part of the present paper deals with representations of pain events in autobiographical memory. In the second part a hindsight bias experiment is used as a prototype of altered information processing in the context of chronic pain. STUDY 1: In study one recollection of pain related events, pain experience and the sensory recalling of pain occurrences were sampled in 20 chronic pain patients, 17 psychiatric patients and 38 healthy controls. Pain patients showed a specific kind of pain related memory which had no parallel among psychiatric patients. Based on learning theory the significance of a pain related memory for chronification is discussed. STUDY 2: In the second study 18 pain patients, 13 psychiatric patients and 18 healthy controls were tested with a hindsight bias experiment. The hindsight-effect was observed in the usual extend in the student control group, but was significantly greater in the pain group and absent in the psychiatric sample. In addition to this global finding, multinomial modeling revealed group differences in specific model parameters. Basic units of information processing interact with the chronification of pain. This method of analysis thus proved as a promising tool for the assessment of cognitive aspects of clinical disorders.

This article reviews the empirical research which has examined the relationships among chronic pain and cognitions like attributions, coping, beliefs, expectations and problem solving. Methods for the examination of pain cognitions and coping strategies are reviewed. Current research which shows the significance of cognitions and coping for the chronification of pain states is reported. These findings are critically discussed. Other methods for future research are presented.

Research on pain-related cognitions has up to now predominantly relied upon introspective questionnaire data. Experimental cognitive psychology offers an alternative way of access to the cognitive aspects of chronical pain. Building on the assumption that information-processing is in part uncontrolled, automatic and pre-attentive, similar processes are also expected to be relevant for pain-relevant cognitions and to be involved in health-related convictions and in coping strategies that can be assessed with questionnaires. Cognitive-psychological research has established the "hindsight bias" as a robust phenomenon that occurs uncontrolled and automatically in diverse contexts when a prior judgment or prediction is assimilated to information received later on. The hindsight bias may be regarded as a manifestation of a universal cognitive mechanism, meaning that information (including information about emotional states) available at a given time will change the memory of prior judgments or of predictions of future events and results of behavior. Cognitive biases similar to the hindsight effect have been demonstrated in chronical pain patients. The present work elaborates the hypothesis that pain patients differ from other groups in the size of the hindsight bias and in its composition and outlines how it can contribute to the chronification of pain. Data from a hindsight-bias experiment comparing pain patients, psychiatric patients and students are analyzed using alternatively a traditional global hindsight bias score ("Hell-Index") and a multinomial modelling approach. The hindsight-effect was observed in the usual extent in the student control group, but was significantly greater in the pain group and absent in the psychiatric sample. In addition to this global finding, multinomial modelling revealed group differences in specific model parameters. This method of analysis thus proved as promising for the assessment of cognitive aspects of clinical disorders.

Indications and modalities of quality control in infrainguinal bypass surgery are reviewed and discussed. A concept and an armamentarium for its practical use are presented. The majority of graft occlusions occur during the first postoperative year. Most failures in the first month are due to technical errors. Many of these can be detected by intraoperative completion control, and immediately repaired. This contributes to improved graft patency rates. In the further course, myo-intimal hyperplasia accounts for most graft stenoses and occlusions. If stenoses are detected and dilated before occlusion occurs, long-term patency is but little impaired. Conversely, patency rates are clearly inferior in grafts following thrombectomy or thrombolysis. Therefore, identification of failing grafts and avoidance of failure are the objectives of surveillance. We have followed routinely a surveillance program since 1991. During surgery, grafts were controlled by completion angiography. Arterial pressures were measured and the ankle-brachial index calculated postoperatively and 1, 3, 6 and 12 months after surgery. In addition, a number of grafts were followed by duplex sonography. Data were stored in an electronic data base featuring several interactive functions. E.g., ankle-brachial and duplex-sonography indices were calculated and rated automatically according to current criteria. Secondary patency after 18 months was 86 per cent in suprageniculate femoro-popliteal bypass grafts, 84 per cent in infrageniculate and 65 per cent in crural (n = 19/23/27).

Evaluation of the spoken and written language skills of prelingually deaf pupils is necessary to improve existing language curricula. Research on written language shows notable delays and substantial differences in the development of written language in comparison to hearing peers. It is difficult to investigate the spontaneous speech because of methodological problems (no control of speech parameters, language becomes a confounding variable). The written language is therefore a good indicator of language development. Nevertheless, oral communication ability can only be studied through spoken utterances. The present study deals with oral and writing performance of 23 prelingually deaf pupils from 9 to 15 years of age whose hearing losses range from 85 to 117 dB. Tape-recorded short picture sequences described by the children and adolescents were examined by experienced listeners. Furthermore, the written narratives of these picture sequences were also analyzed. Parameters included frequency of occurrence of content and function words, type-token ratio, mean length of sentence, and speech fluency. Speech intelligibility was rated by a panel of naive listeners. The results demonstrate the enormous retardation of oral and written language development and specific qualitative differences compared to hearing children. Language skills improve with age, especially in writing. However, oral and written narrative abilities are positively correlated. The loss of sound requires substitutional media for the acquisition of a formal language system. This should be taken into account in the teaching of language to the deaf in order to build up a language competence which is adequate for their age.

In previous experiments our group has shown that test subjects with normal hearing are able to draw pertinent information from visual signals generated from the analysis and transformation of speech. However, the results of these tests could be applied indiscriminately to the deaf. More recently we have studied the speed with which deaf subjects could learn to identify visual patterns generated from speech, the stability of learning, and the strategies developed by our subjects for learning sonogram-like patterns. The subjects tested were taught under two different conditions: pedagogy based on sign language and pedagogy based on speech. Deaf subjects and subjects with normal hearing dealt with associating visual patterns with meanings in a similar fashion. Deaf subjects required more repetitions to associate patterns with meanings than those with normal hearing, but they needed less time. The deaf developed strategies that increased their ability to learn new lists of patterns. In general, the deaf learned lists of patterns in the framework of feedback training well. Interestingly, the deaf taught on the basis of sign language did better than those taught on the basis of speech.